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Engineering Dept. (3rd floor) Map ` Parcel Permit#_._
House# Date Issued
Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) Fee Q� .
Conservation Office(4th floor)(8:30-9:30/1:00-2:00)
TOWN OF BARNSTABLE
Building Permit Application
Projec reet ndrness 13 s (n) a I Ivy,L4+ S ,
Village / ' t D,,y-s �r>>a S Al L, G 13
Owner e,Ad 10, Al !,VIL S LA I/ Address
Telephone / / j
Permit Request d O V1,p W A e c f c 6 I}� ��� O�d d W (� � .4 I t
j(v) r) La. I—) in, Jow
First Floor square feet Second Floor square feet
Construction Type
Estimated Project Cost $ -a 70 0 .
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House ElYes ElNo On Old King's Highway ❑Yes ElNo
Basement Type: ¢§Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing New Half: Existing New
No.of Bedrooms: Existing New
Total Room Count(not including baths): Existing New First Floor Room Count
Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other
Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
0 Attached(size) ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review#
Current Use Proposed Use
Builder Information
Name V 0,,1 Ll yt S �r, �-to h Telephone Number 7 7Z — 6 3
Address t 9T Ba LA v\.P• License# QQ $ 7 3D
d y 4 o vi, a A a• 0 2-6 0 j Home Improvement Contractor# /0
Worker's Compensation# l,�C_�-3G-aayy71-013
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO G1 y yrto 1
L o, I
SIGNATURE DATE ���
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
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i The Town of Barnstable
MDepartment of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 �,'� Ralph Crossen
Fax: 508-790-6230 _ r Building Commissioner
For office use only
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization,
conversion, improvement, removal, demolition, or construction of an addition to any pre-existing
owner occupied building containing at least one but not more than four dwelling units or to
structures which are adjacent to such residence or building be done by registered contractors, with
certain exceptions,along with other requirements.
Type of Work: Est.Cost '
Address of Work:
Owner's Name
Date of Permit Application: ,�-, —
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under SI,000.
Building not owner-occupied
Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME McROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as t ent of the o er.
S— — 9L
D Registration No.
ate Contractor Name
OR
Date Owner's Name
•`N' The Cotntttottrvealth of Afassachusettc
Department ojl,rdustrial.4ccidents
` t Office of111yesMalions
600 11 aWtingtoit Street
L= -• Boston, Alas. 02111
Workers' Compensation Insurance Affidavit
It an tnf rn
name: RY Ka n.3+I/-
location• I �7 "1 L A w2,
city !`t 11 A to A Ls Q, Phone ti 7 7
I am a homeowner performing all work myself.
1 am a sole proprietor and have no one working; in any capacity
'--,a:.•"°1�Y�...�-ass-_:"1!".^::-. AKpn�-�w1{T,c7��,•: r w.w�.y....�+�` wrr�.!-v...�,��'...�,.,n...�.
I am an employer providing workers' compensation for my employees working on this job.
company name: s 4-v Vi G `,Li f9ti1
address-
1 1
cit cIV 0 11honett• -2 7 _
insurance co. i t'J2i✓ 't'IA /"!M 4 ( Polio•# WG.1 - 3/3. - gc�yg73- 0/3
�- . .-•r... .•r+..-...�.s;err......,.rn�....wr.....h.� ....:s�s.++.w..'+�1�.!�_�'yw'1."�'.•"'...'_"^.."�'!...r.. ....�....
I am a sole proprietor. general contractor, or homeowner(circle one) and have hired the contractors listed below who have
the following workers' compensation polices:
company name-
address:
cin'. trhone N•
insurance co. Polio•a
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� .. .. .... :..r..•r.. _:s•e-.s..:-•�-tt-�^.,:Rig•:`_-,-,- �-s�?•�i-ea�;r,e:• .�'.sr:::
company name:
address-
phone#•
insurance co. policy#
At. ttac_h additional sheet d necessa_7 w� �- �`���^r•_� - _ _ %�_'%�: �� °�:.• —
_ _-_......_.._.�__....-.-. �:.v�.....,r�r- '---�v:��ri•
Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 andiur
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a
copy of this statement may be forwarded to the Once of Investigations of the DIA for coverage verification.
1 do hereby corn. 1•unrler the pain d penalties of perjun•that the information provided above is true and correct.
Signature Date 3 66/T 6
Print name o 6 el V+ Gt✓1 Phone# 7 32
`sr ZI
official use only do not write in this area to be completed by city or town official -
city or town: permit/license p rilluilding Department
C3Licensing 13uard
check if immediate response is required 0Sclectmen's Office
[311calth Depiiethient
contact person: phone M rJOther :
Irerssed 3;95 PJAI
information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the "law", an entpinree is defined as every person in the service of another under anv
contract of hire, express or implied, oral or written.
An eniplorer is defined as an individual, partnership, association. corporation or other legal entity, or anv two or more
the foregoing, enpa�- in a joint enterprise, and including the le`,al representatives of a deceased employer, or the
receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the
owner of a dwelling, house having not more than three apartments and who resides therein, or the occupant of the
dwclling house of another who employs persons to do maintenance , construction or repair work on such dwelling hour
or on the ,rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapicr 152 section '_5 also states that every state or local licensing agency shall --vithhold the issuance or
rencival of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.
Additionallv, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the
performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha•
been presented to the contracting authority.
Applicants
Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supplying company names. address and phone numbers as all affidavits may be submitted to the Department of
Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The
affidavit should be returned to the city or town that the application for the permit or license is being requested.
not the Department of Industrial Accidents. Should you have any questions regarding the "law"or if you are required
to obtain a workers compensation policy, please call the Department at the number listed below.
City oC rowns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pleas:
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions.
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,Ma. 02111
fax #: (617) 727-7749
phone 9: (617) 727-4900 ext. 406, 409 or 375
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DEPARTMENT OF PUBLIC SAFETY
CONSTRUCT ION-.-SUPERVISOR LICENSE
Netb'r -Expires:
�w���stt�cted To•_�-00
-_ ROBERT E RYAN
15 ORCHARD NAY
SANDNICH, MA 02563
� COMMONWEALTH ' - _ ..:. . .. ,,.,.•_. ,.- . . . .:
OF I DEPARTMENT OF PUBLIC
ONE ASHBO SAFETY
MASSACHUSETT3 RTON PLACE Fcllure c to
BOSTON,MA02108 P c"sacurrent
e'-Z840b rsottaSta08illdlog
L I C ENS E �i"�'elsconebtoiredoeat/on
EXPIRATION DATE r��2
C O N S T R. S U P E R y I S O R ostnlst"%*UTl0N
07252�
RESTRICTIONS EFFECTIVE DATE LIC-NO. FOR PROTECTION AGAINST
NONE 06/30/1993 015059 r THEFT, NTRIGHT THUMB,
gT APPROPRIATE
W I LL I AM J R YA N 6 BOX ON LICENSE.
$ 199 BET LAME
m
HYANNIS MA
02601 BLASTING OPERATORS
Z MUST INCLUDE PHOTO.
. ,. PHOTO(BLASTING OPR ONLY) FE m
rho.vo PAID
NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY
HEIGHT: STAMPED-OR-SIGNATURE OF THE COMMISSIONER
C THIS DOCUMENT MUST BE
i` CARRIEOON THE PERSON OF }� p
THE HOLDER WHEN EN- SIGNATURE OF LICENSEE SIGN NAME IN FIlL JBp I :E LINE
OTHERS-RIGHT THUMB PRINT GAGED IN THISOCCUPATION. 'r/AI � ,
EwilrqGWONER
a.
HOME IMPROVEMENT CONTRACTOR
Registration 104952
Type - PARTNERSHIP
EtPiration . 07/16/96
Ryan Construction
4rWil�iaa J. Ryan
ADM'N) ttiR Beth Lan
Hyannis MA 02601
Assessor's office(1st Floor): .
Assessor's map and lot numb L�/`, �7S L' SEPTIC SYSTEM MUST BE o�IN >o
INSTALLED IN COMPLIANCE
y'��•, j low• Conservation(4th Floor): -
Board of Health(3rd flo( WITH TOTLE 5 d
Sewage Permit number ENVIRONMENTAL CODE AND
rua
Engineering Department(3rd floor):"' _ TOWN REGULATIONS onto Yix►���
House number
Definitive Plan Approved by Planning Board ° 19
APPLICATIONS PROCESSED 8:30-9:30 A.M.Viand 1:00-2-00 P.M.only
} TOWN OAF BARNSTABLE
} .BUILDING , INSPECTOR
4 � '
APPLICATION FOR PERMIT TO /J 1 bnf mP_y'} 01/GY- G�OSP�� Ao 6&17 �JGjJ�jt/00�
}TYPE OF CONSTRUCTION
' ! i 19
/
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit accordiing11 to the following information:
Location 3 s Ln1hu� /"1�� a✓Sctrivi c AJ/S
Proposed Use 13aJ�a
Zoning District 1 Fire District
Name of Owner k119_441 4ay-shad f Address �f�Q�✓1Iq t St A yS 1 ei!S /"1)�/C
Name of Builder &CI P 1 l 0 ✓I.0 4yU&�f o Y) Address M ,f ayd [-a ne- t -4,14[s
Name of Architect Address
Number of Rooms Foundation
Exterior �t vi p_ �i�,vh - f.✓A i ie Ccdar sfnI�� oofing 14.5 Ph a S A i ✓1� le—S
Floors ✓I d Interior 1-0 clone- /b / o j"
Heating Plumbing
Fireplace Approximate Cost 000 . 00
Area SO 5a,
Diagram of Lot and Building with Dimensions Fee
I
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above cons ruction.
Name
Construction Si ipervisor's License O I SOS
MARSHALL, KENNETH
�7��2
I No Permit For ADD TO DWELLING
Location 135 Walnut St, Marstons Mills
Owner Kenneth Marshall
Type of Construction
•r
Plot Lot
Permit Granted May 25 19 94
Date of Inspection:
Frarm 19
Insulation 19
r io-
r�Fireplace • 19
Date Completed r 19 = '
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COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY , FsB�1<r®toposa�ssacanent
OF ONE PLACE ( P�= A+isottaSt�PBaf►�is$MA99ACHUSETTS BOSTON,M MA A 021010 8 GodAIseau"fer-revocalon'
a: LICENSE o9tA►a//ast ►TION
EXPIRATION DATE 0,7 ry C O N S T R. SUPERVISOR I
04/06/1996 0 EFFECTIVE DATE, -LIC-NO. FOR PROTECTION AGAINST
RESTRICTIONS THEFT, PUT RIGHT THUMB
NONE 06/30/1993 015059 0 ) PRINT IN APPROPRIATE
BOX ON LICENSE.
WILLIAM J RYAN
199 B ETH LANE g BLASTING OPERATORS
HYANNIS MA 02601 m MUST INCLUDE PHOTO.
PHOTO(BLASTING CPR ONLY) FEf* I D A
00.00 NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY
HEIGHT: STAMPED-OR-SIGNATURE OF THE COMMISSIONER
--- 1
THIS DOCUMENT MUST BE « SIGN NAME IN F L O IG RE LINE
CARRIEDON THE PERSON OF SIGNATURE OF LICENSEE j � 8
THE HOLDER WHEN EN- _
OTHERS-RIGHT THUMB PRINT GAGED IN THIS OCCUPATION. If ONER
I
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��ie l�o�xono�ucra�i o�✓�afaae%ute�lo
HOME IMPROVEMENT CONTRACTOR
Registration 104i52
Type - DBA
Expiration 07/16/94
Ryan Construction
William 1. Ryan
199 Beth Lane -
ADMINISTAATOR Hyannis MA 02601
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COMMONWEALTH, OF MA$SACHUS "I'S
n
`c DErAR—,mm 'T OF LNDUSTRIArf►ACCIDENTS :F`L •
600 WASHINGTON S;R�Fr
jameS J CanDoei: BOSTON, MASSACHUSETIS 02111
;o nrn:ssrone. WORKERS' COMPENSATION INSURANCE AFFIDAVIT
1 tta
AJ
gicCnsWpertnttzec K'
with a pnnapal plan of business/residenc�e act s a
� ni• 6fV�€,t.
IT T Y �'Nry
` _ G Stsu/Zt
'.S,-t '�
?.. �5 *+.,`. 4� •J� .{.� Y a+K'�S
`• do hereby cclLlfy;under the patru.and°p�aalaa` cf��tuy�;i6 '' E'.t.x I.k`. •t.�
[J 1 am an employer providing the following workers'compensation coverage for my employees working on this
job.
WC1 o i3
Insurance Co pany Policy Number
() 1 am a sole proprietor and have no one working for me.
przt•wust-;p
() I am a sole proprietor, eneral contractor r homeowner(circle one)and have hired the contractors listed below
who have the following wor ers compensation insurance policies: -
Name of Contractor Insurance Company/Policy Number
Name of Contractor Insurance Company/Policy Number
Name of Contractor Insurance Company/Policy Number
0 1 am a homeowner performing all the work:myself.
NOTE.Please be aware that while homeowners who ereplov persons to do tna-intenanee,construction or.rcpair work-on a
dweiiinc of not more than t rcc units in which the homeowner also resides or on tic grounds appurtenant tbereto arc not ceneraliv
considered to be emplovers undcr the Workers' Comvcnsation Act(CL C 152.see-- 10)).application by a homeowoer for a license
or permit may evidence the lcral status of an emplovrr under the Corkers'Compcosation Act
1 unecn_:and t^a:;coy.*o:t:::s st:tc-ncr.;will be forw uccd to the Erna:mcnt of lncus:r J Accidents'Office:of lnsuranct for coverage
vcr ,:l;:;ion :rc - to sc:..:c covc:_.ec ss rccu::cc under Scc'on?5.:'of MGL'52 csr,icaa to t:�c imposition of erir.-L per•:1ti`
consisc-z of:11:c et uc to S 1500.00 an&or irnnrisorrncrt of up to one vc:.r sac c•:i ocn:.:aa in the form of:Stop Work Order aae a
fine of S l 00.00 a cav against me.
Signed this d2v of S' L- , 19 Q
R RN CONS�'2�d,y _
LICC n 1:_:P::-:1-__
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